European Resuscitation Council Guidelines for Resuscitation ... - CPR

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18 de 0ctubre de 2010 www.elsuapdetodos.com1280 R.W. Koster et al. / Resuscitation 81 (2010) 1277–1292Fig. 2.7. Place the heel of one hand in the centre of the victim’s chest.Fig. 2.5. Head tilt and chin lift.• start chest compression as follows:◦ kneel by the side of the victim;◦ place the heel of one hand in the centre of the victim’schest; (which is the lower half of the victim’s breastbone(sternum)) (Fig. 2.7);◦ place the heel of your other hand on top of the first hand(Fig. 2.8);◦ interlock the fingers of your hands and ensure that pressureis not applied over the victim’s ribs. Keep your armsstraight (Fig. 2.9). Do not apply any pressure over the upperabdomen or the bottom end of the bony sternum (breastbone);◦ position yourself vertically above the victim’s chest andpress down on the sternum at least 5 cm (but not exceeding6cm)(Fig. 2.10);◦ after each compression, release all the pressure on thechest without losing contact between your hands and thesternum; repeat at a rate of at least 100 min −1 (but notexceeding 120 min −1 );◦ compression and release should take equal amounts oftime.6a. Combine chest compression with rescue breaths.• After 30 compressions open the airway again using head tiltand chin lift (Fig. 2.5).• Pinch the soft part of the nose closed, using the index fingerand thumb of your hand on the forehead.• Allow the mouth to open, but maintain chin lift.• Take a normal breath and place your lips around his mouth,making sure that you have a good seal.• Blow steadily into the mouth while watching for the chest torise (Fig. 2.11), taking about 1 s as in normal breathing; this isan effective rescue breath.• Maintaining head tilt and chin lift, take your mouth away fromthe victim and watch for the chest to fall as air comes out(Fig. 2.12).• Take another normal breath and blow into the victim’s mouthonce more to achieve a total of two effective rescue breaths.The two breaths should not take more than 5 s in all. Thenreturn your hands without delay to the correct position onthe sternum and give a further 30 chest compressions.• Continue with chest compressions and rescue breaths in aratio of 30:2.• Stop to recheck the victim only if he starts to wake up: tomove, open eyes and to breathe normally. Otherwise, do notinterrupt resuscitation.www.elsuapdetodos.comFig. 2.6. Look, listen and feel for normal breathing.Fig. 2.8. Place the heel of your other hand on top of the first hand.
18 de 0ctubre de 2010 www.elsuapdetodos.comR.W. Koster et al. / Resuscitation 81 (2010) 1277–1292 1281Fig. 2.9. Interlock the fingers of your hands. Keep your arms straight.If your initial rescue breath does not make the chest rise asin normal breathing, then before your next attempt:• look into the victim’s mouth and remove any obstruction;• recheck that there is adequate head tilt and chin lift;• do not attempt more than two breaths each time beforereturning to chest compressions.If there is more than one rescuer present, another rescuershould take over delivering CPR every 2 min to preventfatigue. Ensure that interruption of chest compressions isminimal during the changeover of rescuers. For this purpose,and to count 30 compressions at the required rate, it maybe helpful for the rescuer performing chest compressionsto count out loud. Experienced rescuers could do combinedtwo-rescuer CPR and in that situation they should exchangeroles/places every 2 min.6b. Chest-compression-only CPR may be used as follows:• If you are not trained, or are unwilling to give rescue breaths,give chest compressions only.• If only chest compressions are given, these should be continuous,at a rate of at least 100 min −1 (but not exceeding120 min −1 ).7. Do not interrupt resuscitation until:• professional help arrives and takes over; or• the victim starts to wake up: to move, open eyes and tobreathe normally; or• you become exhausted.Fig. 2.10. Press down on the sternum at least 5 cm.movement. 49 Therefore, the lay rescuer should open the airwayusing a head-tilt-chin-lift manoeuvre for both injured and noninjuredvictims.Recognition of cardiorespiratory arrestChecking the carotid pulse (or any other pulse) is an inaccuratemethod of confirming the presence or absence of circulation,both for lay rescuers and for professionals. 50–52 There is, however,no evidence that checking for movement, breathing or coughing(“signs of a circulation”) is diagnostically superior. Healthcarewww.elsuapdetodos.comOpening the airwayThe jaw thrust is not recommended for lay rescuers becauseit is difficult to learn and perform and may itself cause spinalFig. 2.11. Blow steadily into his mouth whilst watching for his chest to rise.
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European Resuscitation Council Guidelines for Resuscitation ... - CPR

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